Q) Which of the following is an Adverse factor hindering spontaneous fistula closure:
a) Tract <1cm
b)Transferrin > 200
c) Location in esophagus
d) First surgery done in the same institution
a) Tract less than 1 cm
Spontaneous fistula closure
Short-turnover protein (prealbumin, retinol-binding protein, transferrin) levels should be measured at least weekly to assess the adequacy of protein delivery. An ongoing catabolic state will adversely affect short-turnover protein levels, even with maximal protein delivery.
Failure of an enterocutaneous fistula to close spontaneously is associated with acronym FRIENDS):
the presence of a foreign body within the tract or adjacent to it, previous radiation exposure of the site, ongoing inflammation (most commonly from Crohn disease) or infection that contributes to a catabolic state, epithelialization of the fistula tract (particularly if the fistula tract is less than 2 cm long), neoplasm, distal intestinal obstruction, and pharmacologic doses of steroids.
Fistulas associated with a concurrent pancreatic fistula also have a low rate of spontaneous closure, as do those occurring in the presence of malnutrition or adjacent infection.
In general, anatomic locations that are favorable for closure are the oropharynx, esophagus, duodenal stump, pancreas, biliary tree, and jejunum.
Q) An infant presents with duodenal atresia. Which of the following is true about this condition?
a) It is the most common GI atresia
b) It presents soon after birth with non bilious vomiting
c) Pre natal detection of duodenal atresia is common
d) Gastro jejunostomy is the procedure of choice to bypass the obstruction
Answer
C-
Commonly detected in the pre natal ultrasound
Duodenal atresia is seen in 1:5000 live births .Most common atresia is jejunoileal (1 in 2000). It is associated with lot of other congenital malformations like Down's, prematurity, biliary atresia etc.
Duodenal atresia can have many stages like duodenal webs, complete stenosis and complete separation.
Mostly (80%) stenosis is distal to the ampulla of vater so the bile coming out from the ampulla goes in the stomach and infant presents with bilious emesis.
Typical radiographic sign is double bubble. One bubble in stomach and one in duodenum. Ante natal sonography is able to pick up most cases.
Double Bubble
Surgical options include- Duodenoduodenostomy and Duodenojejunostomy.
Another related MCQ to this question is that Double bubble sign is seen in which other conditions
Duodenal stenosis
Annular Pancreas
Atresia of duodenum
Understanding Duodenal Atresia in Infants: Key Facts and Diagnostic Insights
Duodenal atresia is a congenital condition that affects newborns, impacting their gastrointestinal (GI) system. While not the most common form of GI atresia, it is a significant condition that requires early detection and treatment. This article delves into the critical aspects of duodenal atresia, including its symptoms, diagnosis, and treatment options.
What is Duodenal Atresia?
Duodenal atresia is a congenital obstruction of the duodenum, the first part of the small intestine. This condition occurs in approximately 1 in 5,000 live births and is associated with other congenital malformations, such as Down syndrome, prematurity, and biliary atresia.
Prenatal Detection of Duodenal Atresia
Early Diagnosis through Ultrasound
One of the most notable aspects of duodenal atresia is that it is commonly detected during prenatal ultrasounds. Advances in antenatal sonography allow doctors to identify most cases before birth, providing an opportunity for early planning and intervention. The typical sign on ultrasound is a "double bubble" appearance, which indicates the presence of fluid-filled areas in both the stomach and duodenum.
Symptoms and Presentation
Bilious Vomiting After Birth
Duodenal atresia typically presents soon after birth, with one of the hallmark symptoms being bilious vomiting. In around 80% of cases, the obstruction is located distal to the ampulla of Vater, allowing bile from the liver to mix with stomach contents, leading to greenish, bilious emesis.
Associated Congenital Conditions
Infants with duodenal atresia may also present with other congenital anomalies, such as Down syndrome, heart defects, or other gastrointestinal malformations like jejunoileal atresia, which is actually the most common type of GI atresia (occurring in 1 in 2,000 live births).
Types of Duodenal Obstructions
Stages of Duodenal Atresia
Duodenal atresia can occur in various forms, ranging from partial obstruction, such as duodenal webs, to complete separation of the duodenum. These different forms dictate the severity of symptoms and the urgency of intervention.
Duodenal Webs – Thin membranes that partially block the duodenum.
Stenosis – A narrowing of the duodenum that restricts food passage.
Complete Atresia – A total obstruction where the duodenum is completely separated.
Diagnostic Features
Double Bubble Sign on Imaging
Postnatally, duodenal atresia is diagnosed through abdominal imaging, with the "double bubble" sign being a classic radiographic finding. This sign appears as two distinct gas-filled bubbles—one in the stomach and one in the duodenum—indicating the obstruction.
Treatment of Duodenal Atresia
Surgical Intervention
The treatment for duodenal atresia is surgical, with the goal of bypassing or removing the obstruction. Contrary to some misconceptions, gastrojejunostomy is not the preferred procedure. Instead, a duodenoduodenostomy is often performed to connect the two ends of the duodenum, allowing normal passage of food from the stomach to the intestines.
Post-Surgical Outlook
With early surgical intervention, the prognosis for infants with duodenal atresia is generally positive. Post-operative care is crucial to ensure proper digestion and prevent complications such as infection or malabsorption.
